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Minority rules on euthanasia

18 April 2016 3 Comments

Last week, former prime minister Bob Hawke came out in favour of voluntary-assisted dying. The fact is that many attempts over the years have been made to pass a voluntary assisted dying law in Australia, but none has succeeded.

This is despite overwhelming public support (between 70 and 80 per cent) for the idea that terminally ill people who are suffering unbearably should be able to ask a doctor to help them end their life quickly and painlessly.

This level of support exists across all the survey categories of gender, age, religion and political allegiance.

Compassionate doctors in Australia already help suffering patients to die, but have to do so covertly.

Lengthy experience in Switzerland, Oregon, the Netherlands and Belgium demonstrates that legal safeguards have prevented exploitation of the vulnerable.

And the “dying with dignity” movement is growing, most recently in California, which last year passed a Death with Dignity law. Moreover last Thursday, the Trudeau government introduced similar legislation into parliament in Ottawa.

So why have Australian politicians not embraced a clear and compassionate vote-winner that has proven to be safe?

In Victoria, an upper house Parliamentary Committee is facing up to this question, and is looking thoroughly at end-of-life choices.

The committee’s composition is balanced, including three Liberals, three Labor members, a Green, and the leader of the Australian Sex Party Fiona Patten, who was instrumental in achieving agreement to set up the committee. As it happens, as party policy the Sex Party and the Greens both support voluntary assisted dying.

Since May 2015, the Victorian committee has held 17 public hearings and has received more than 1000 submissions. It has heard from doctors, nurses, palliative and aged care specialists, legal experts, ethicists, academics, religious bodies, community organisations and, crucially, from the dying themselves and their families and friends.

Before finalising its report on May 31 this year, the committee is currently studying the experience of voluntary assisted dying legislation in America and Europe.

A primary source of information for the committee, I suggest, is the Quebec Parliament, which passed an Act Respecting End-of-Life Care in 2014. This was based on a comprehensive report by a parliamentary committee, following lengthy consultation with local and overseas experts. Public support in Canada for medically assisted dying was over 75 per cent.

The Quebec Parliamentary Committee posed the question: “How should we respond to requests for help to die?”

Its conclusion was to propose “medical aid in dying”, because that “is consistent with the changes in our values, the law and medical practice”, because “palliative care cannot ease all physical and psychological suffering”, and because “allowing this practice would not harm society’s most vulnerable”.

The Victorian committee will also be addressing ethical values and overseas experience. I hope it will recognise that there is no set of universally acceptable ethics , even among members of the same religious faith.

For example, the Australian Catholic Bishops Conference argues that “killing” is wrong because the Church believes that there is an absolute value in every person’s life that takes precedence over personal autonomy. The bishops’ quote with approval the view that anyone who thinks their life is no longer worth living, even if they are suffering hopelessly, is “misguided”.

As with other religious institutions, when it comes to voluntary assisted dying the Catholic Church does not permit individual choice. Yet, currently, more than 70 per cent of Catholics actually support a voluntary assisted dying law. Their ethical values put them in direct opposition to their Church’s hierarchy.

They are in part represented by the organisation “Christians Supporting Choice For Voluntary Euthanasia”, which believes that “as a demonstration of love and compassion, those with a terminal or hopeless illness should have the option of a pain-free, peaceful and dignified death”.

That ethical values are subjective, not universally applicable, is also shown by the conflicting opinions of doctors.

The Australian Medical Association considers voluntary assisted dying to be inconsistent with what it sees as the role of doctors as healers. Similarly, the organisation “Doctors Opposed to Euthanasia” maintains that “the prohibition of intentional killing is a bedrock of both the law and medical ethics”.

On the other hand, there is a widespread view that the doctor’s role includes relief of suffering, even if that means the death of the patient. The equivalent in Quebec of the AMA is the College des medecins du Quebec which argues that “there are certain exceptional situations , uncontrollable pain or interminable suffering, for example , in which euthanasia could be considered to be a final step required to ensure provision of quality care”.

The Canadians acknowledge the reality that compassionate doctors do help suffering people to die, even though this is technically illegal. Similarly, Australian research has found that a third of the doctors surveyed had given dying patients more drugs than were necessary to relieve suffering, with the intention of hastening their death.

In its submission to the Victorian enquiry, the Australian Catholic Bishops said that “where euthanasia has been legalised, it has been disastrous for the vulnerable” and “the evidence from all places that have attempted to legalise and regulate euthanasia is that it is not possible to draft safeguards that would effectively protect vulnerable people from subtle or overt pressure to request euthanasia”.

This does not fit with the findings of the Quebec Parliamentary Committee which after a number of visits overseas, reported that “we did not observe any abuse associated with the feared slippery slope”. It quoted the Royal Dutch Medical Association: “The slippery slope has not materialised, i.e. euthanasia has not increased among people over age 80, the disabled, the chronically ill, the economically disadvantaged or other groups.”

The Committee noted “a handful” of technical breaches of the laws in the Netherlands and Belgium, where some formal procedures were not followed. However it observed that there had been no court cases, no media outrage and no diminution in popular or medical support for voluntary euthanasia.

All of the above makes me wonder if the Australian bishops and the Quebec Committee were looking at the same information!

In a secular society like ours, legislation should not be based on the view of the hierarchy of a particular religious organisation, but on hard evidence.

It is to be hoped that the Victorian Parliamentary committee’s recommendations will do precisely that.

Emeritus professor of history and politics at Griffith University, Ross Fitzgerald, is the author of 39 books, including the co-authored sexual/political satire ‘Going Out Backwards: A Grafton Everest Adventure’, published by Hybrid in Melbourne.

The Canberra Times, 18 April, 2016, CT2 p 4.

3 Comments »

  • Peter Comensoli said:

    Growing euthanasia statistics should be a warning
    ‘Legalised euthanasia endangers the lives of our fellow human beings who are seriously ill, elderly, disabled, have low self-esteem or are otherwise vulnerable.’
    There’s nothing compassionate or safe about killing our fellow travellers along the journey of life.

    Accepting euthanasia means agreeing some people are beyond any help, for whom taking their life is the only option. I reject that pessimism. I reject the idea that euthanising someone is any sort of solution to the deeply human reality of facing our own mortality. That is a most callous and irresponsible choice. Doctors should instead help people to live their lives well as they make their final journey towards death.

    Rather than buying into the dangerous and dishonest euphemism of “dying with dignity”, we would do better – and be more human – by dignifying the lives of the dying. Palliative care is one key way we can dignify the dying. We should not accept the chronic under-funding of palliative care in this country and offer lethal injections instead.

    Euthanasia is not turning off a life support machine where there is no prospect of recovery. It is not ending treatment that is overly burdensome. It is not giving someone pain relief as they are dying. Rather, euthanasia is giving someone a drug with the intention of ending their life.

    Ross Fitzgerald embraces a pessimistic, reductionist view of life. He calls on the Catholic Church to provide hard evidence of the problems with euthanasia. I’m happy to oblige.

    Fitzgerald highlights the Canadian parliamentary inquiry that suggests euthanasia can be readily legalised and properly controlled. He does not mention that the same overseas experience indicates that the categories of people who can be legally euthanised is increasing, the number of individuals being euthanised is growing rapidly, and many of the rules in place are being routinely ignored.

    “The clear conclusion of reason and experience is that euthanasia or assisted suicide cannot be made safe, because no law can prevent vulnerable people from abuse.” – Peter Comensoli

    The Lancet reported in 2014 that the law was changed in Belgium to remove any age limit so competent children can request euthanasia with their parents’ consent. Laws in The Netherlands were changed to permit euthanasia from 12 years old with parental consent and from 16 years of age without parental consent. It also allows for the euthanasia of newborns with poor prognosis, in agreement with the child’s parents.

    Let’s look at the increase in numbers of people dying by euthanasia. The American Medical Association’s Journal of Internal Medicine published an article this year that shows that in The Netherlands 3.3 per cent (one in 30) of deaths were by euthanasia in 2013, three times the percentage in 2002. In Flanders, Belgium 4.6 per cent (one in 24) deaths were by euthanasia in 2013, up from 1.9 per cent in 2007.

    And lastly, the failure of laws. The Canadian Medical Association Journal published a report that shows that one third of euthanasia cases in Flanders, Belgium are without explicit consent. An article in the British Medical Journal shows only half the euthanasia cases in Flanders are reported as legally required. Another article in the Canadian Medical Association Journal says life-ending drugs are administered by nurses in Belgium in almost half the cases of assisted death without an explicit request.

    An article published in The Lancet says 23 per cent of deaths by euthanasia in The Netherlands are not reported to authorities. Statistics Netherlands reported there were 310 euthanasia deaths without explicit consent in 2010.

    A number of high profile cases in recent years have shown how the laws work. In 2012 a 64-year-old Dutch woman was euthanised because she was deemed to have “untreatable depression”. In 2013 43-year-old identical twins in Belgium were euthanised after they found they had a genetic condition that meant they would lose their sight. In 2015 an 85-year-old Belgian woman was euthanised because she grieved deeply after the death of her daughter and said she had nothing to live for.

    The clear conclusion of reason and experience is that euthanasia or assisted suicide cannot be made safe, because no law can prevent vulnerable people from abuse. The evidence from places that have attempted to legalise and regulate euthanasia is that it is not possible to draft safeguards that would effectively protect vulnerable people from subtle or overt pressure to request euthanasia.

    Legalised euthanasia endangers the lives of our fellow human beings who are seriously ill, elderly, disabled, have low self-esteem or are otherwise vulnerable. People should have our care and the ongoing protection of our laws; not a lethal injection.

    Peter Comensoli is the Catholic Bishop of Broken Bay and spokesman on life issues for the Australian Catholic Bishops Conference.

    The Canberra Times, April 20, 2016

  • Dr Peter Smith said:

    POLITICIANS SCARED

    Ross Fitzgerald (“Minority rules on euthanasia”, Times2, April 18, p4) makes clear that our politicians are so fearful of the clergy that they ignore the majority of Australians who are frustrated by the lack of change.

    No wonder Professor Fitzgerald has joined the Australian Sex Party to support Fiona Patten MP as she campaigns to legalise voluntary euthanasia in Victoria.

    Dr Peter Smith, Lake Illawarra, NSW

    The Canberra Times, 21 April, 2016

  • Michael O'Brien said:

    Professor Fitzgerald (“Minority rules on euthanasia”, Times2, April 18, p4) is right in his robust criticism of our secular and clerical leaders, for being so out of touch with modern thought when it comes to thisvery important issue.

    Like so many of us who have had to see the suffering that our loved ones have had to bear at the end, I say the time has come to demand that our leaders get on board and enact laws to decriminalise euthanasia. Like capital punishment and suicide, it takes a groundswell of public opinion to move the legislature to pass laws that are existentially, humanistically and inherently right.

    This is especially so when the clergy demand preservation of the status quo. It is time to make erstwhile the horror shows we all witness. Go ahead, leaders, lead.

    Michael O’Brien, Newtown, NSW

    The Canberra Times, 22 April 2016

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